ICU may have to ration care among patients with best chance of survival

Dr Tony Holohan, the chief medical officer, at last night's briefing update on Covid-19. Picture: Sasko Lazarov/RollingNews.ie

Intensive care staff in West Cork may soon have to 'ration' care among those who have the best chance of survival.

As Ireland registers the highest proportion of Covid-19 cases in the world and the health system is put under increasing pressure, Dr Brian Carey, a consultant physician at Bantry General Hospital, has issued a warning to GPs and other medical staff in the Bantry area, saying that the situation is changing rapidly and they may have to make difficult decisions to treat patients in ICU who are the most likely to survive.

The warning came as health officials said up to 2,500 patients could require hospitalisation by the middle of the month, and after it emerged that Ireland had the highest Covid-19 infection rate in the world last week, after 45,700 cases were recorded.

Last night, a further 4,929 cases of the virus were confirmed by health officials, who painted a bleak picture of the presence of the virus in the community.

Dr Tony Holohan, the chief medical officer, said data shows that socialising returned to an almost pre-pandemic level in December, contributing to the current spike.

Professor Philip Nolan, chair of the National Public Health Emergency Team's Epidemiological Modelling Advisory Group, told a briefing that one in 76 of the entire population has been notified as Covid-positive in the last fortnight. 

Almost one-quarter of all of Ireland's hospitalisations since the pandemic began came in the last week, with the health service creaking under pressure as ICU beds are in limited supply.

Prof Nolan said forecasts indicate that 2,200-2,500 patients may need hospitalisation by the middle of the month, with ICU numbers ranging between 200 and 400.

Despite this, Dr Michael Power, HSE clinical lead for intensive care, said private hospitals have not yet been asked to supply ICU staff to public hospitals. However, he clarified, 1,300 ICU-trained staff working in other areas in the HSE have been asked to return to ICU.

In the south of the country, Dr Carey, at Bantry General Hospital, wrote to GPs and other medical staff to warn of the "extreme pressures" in the hospital, which is in the middle of an outbreak on the wards.

"We strongly advise admission avoidance for all patients unless absolutely necessary," Dr Carey told staff in a communique.

In addition, we are rapidly approaching full capacity of ICU beds in the region.

"We may soon reach a point where ICU admissions are rationed and only offered to those with the best chance of survival. The situation is changing rapidly."

This follows a decision by the South/South West Hospital Group, which includes Cork University Hospital, to cancel all elective work.

There was a ray of light, though, as Professor Karina Butler, chair of the National Immunisation Advisory Committee, said the first doses of the Moderna vaccines should reach Ireland before the end of the week.

She said, in relation to the Pfizer/BioNtech vaccine, that “early evidence is emerging that immunity lasts for six months, possibly 18 months”. 

The Government plan is to have vaccinated 700,000 people by the end of March. This includes those in nursing homes, frontline healthcare workers, and the over-70s, according to Health Minister Stephen Donnelly.

“Our plan is based on vaccines ordered from Pfizer and Moderna as well as our estimated allocation from AstraZeneca, which must be approved by the regulator," he posted online last night. 

"We are working on the basis of having 1.4m-plus vaccines by the end of March."

Ireland should receive a lot more vaccines in April. 

MEP Billy Kelleher has criticised the vaccine delivery schedule in Ireland in contrast to our European neighbours, including Germany and France.

Media reports in German magazine Der Spiegel alleged that Germany will receive an additional 30m doses of the Moderna vaccine and that France and Germany will also receive more doses of the Pfizer/BioNtech vaccine.

Mr Kelleher said this "flies in the face of the concept of European solidarity".